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 “The very large difference in disease rates between countries is a
pretty good indication that it is possible to achieve much better
outcomes,” said Theo Vos of the Institute for Health Metrics and
Evaluation at the University of Washington in Seattle, coauthor of
the new report.
But this would require a combination of factors, Vos said, including
higher maternal education, since educated mothers are more likely to
have their kids vaccinated or adopt malaria bednets, for example.
Better outcomes could result not just from prevention but also from
better management of illness - and therefore better survival, he
said.
“Some things require a systems approach,” Vos told Reuters Health by
email. “In countries with dysfunctional government and health care
systems, the things we know that work and can lower disease burden
are not being provided or (are) provided with inadequate quality.”
Researchers for the Global Burden of Disease Study analyzed death
and injury data from 188 countries for three groups of youngsters:
under age five, ages five to nine, and ages 10 to 19.
Altogether, they counted 7.7 million deaths globally in 2013, more
than 6 million of which were in children under age five.
Top causes of death were lower respiratory tract infections for
younger children, diarrheal diseases for older children and road
injuries for teens.
Iron deficiency anemia affected 619 million children and teens in
2013 and was the leading cause of living with disability.
Overall, deaths decreased from 1990 to 2013, and in countries with
rapid declines over the 23-year period, deaths from leading causes
also declined rapidly. But countries with slower overall declines
sometimes had increasing deaths from the leading causes, or no
change.
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In 2013, Nigeria accounted for more than a third of the deaths from
malaria and India accounted for a third of deaths from neonatal
encephalopathy, usually caused by lack of oxygen during birth, the
researchers reported in JAMA Pediatrics. India, the Democratic
Republic of the Congo, Pakistan, Nigeria and Ethiopia together
accounted for half of diarrheal deaths among children.
Safe water and sanitation and improved hygiene, improved nutrition,
and vaccine availability for important diarrheal diseases could
bring those numbers down, Vos said.
“There are some regions being left behind, and it’s not a big
surprise, those places are characterized by war, political
instability and very weak governance,” said Dr. Paul H. Wise of
Stanford University in California, who coauthored an editorial
alongside the results.
“It wasn’t a coincidence that Ebola took off in countries with a
history of conflict,” he told Reuters Health by phone.
“Syria has become hell on earth for everybody but particularly for
children and there’s no good way to gauge accurately the human
destruction that is taking place” from direct casualties of war and
indirect casualties, like destruction of hospitals, clean water
sources and lack of vaccines, he said.
SOURCE: http://bit.ly/1Sf5wKD JAMA Pediatrics, online January 25,
2016.
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